Tag Archives: malpractice

10 Things That Will Get You Sued – Part 3

#7. Inappropriate prescribing

Most trauma professionals worry about over-prescribing pain medication. But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Always do the math and make sure you are sending the right drug in the right amount home with your patient. If the patient’s needs are outside the usual range, work with their primary provider or a pain clinic to help optimize their care.

#8. Improper care during an emergency

This situation can occur in the emergency department when the emergency physician calls a specialist to assist with management. If the specialist insists on the emergency physician providing care because they do not want to come to the hospital, the specialist opens themselves up to major problems if any actual or perceived problem occurs afterwards. The emergency physician should be sure to convey their concerns very clearly, tell the specialist that the conversation will be documented carefully, and then do so. Specialists, make sure you understand the emergency physician’s concerns and clearly explain why you think you don’t need to see the patient in person. And if there is any doubt, always go see the patient.

#9. Failure to get informed consent

In emergency situations, this is generally not an issue. Attempts should be made to communicate with the patient or their surrogate to explain what needs to happen. However, life or limb saving procedures must not be delayed if informed consent cannot be obtained. Be sure to fill out a consent as soon as practical, and document any attempts that were made to obtain it. In urgent or elective situations, always discuss the procedure completely, and provide realistic information on expected outcomes and possible complications. Make sure all is documented well on the consent or in the EHR. And realize that if you utilize your surrogates to get the consent (midlevel providers, residents), you are increasing the likelihood that some of the information has not been conveyed as you would like.

#10. Letting noncompliant patients take charge

Some patients are noncompliant by nature, some are noncompliant because they are not competent (intoxicated, head injured). You must use your judgment to discern the difference between the two. Always try to act in the best interest of your patient. Document your decisions thoroughly, and don’t hesitate to involve your legal / psych / social work teams.

Related post:

10 Things That Will Get You Sued – Part 2

#3. You are responsible for the conduct of your staff

If the people who work for you treat patients poorly, you may be responsible. It is important that your staff have bedside manner at least as good as yours.

#4. Avoiding your patients

Some of your patients may need to contact you, either while in the hospital or while at home. Don’t appear to be inaccessible. This is an extension of your bedside manner. Return phone calls or messages promptly, or have one of your staff do so. Make time to meet with patient families while in the hospital. Remember, you deal with trauma all the time; this is probably the first time they have and it is extremely stressful.

#5. Ordering a test without checking the result

I presume that if you order a test, you are interested in the result. And hopefully it will make some difference in patient care. If not, don’t order it. But if you do order a test, always check the result. If a critical result is found, don’t assume that “someone” will tell you about it. You are responsible for checking it and dealing with any subsequent orders or followup that is needed.

#6. “What we have here is a failure to communicate” – part 2

Most of the time, our patients have primary care providers somewhere. Make it a point to identify them and keep them in the loop. Provide, at a minimum, a copy of the discharge summary from the hospital or emergency department. If new therapies of any kind are started, make sure they are aware. And if an “incidentaloma” is found (a new medical condition found on lab tests or imaging studies), followup with the primary care provider to make sure that they are aware of it so they can take over responsibility for further diagnosis or treatment.

Tune in for the final installment in my next post.

Related post:

10 Things That Will Get You Sued – Part 1

Many trauma professionals believe that they can only be sued if they make a medical error and some harm occurs. Unfortunately, this is not entirely true. Yes, this is one obvious way to spark a suit or claim. 

Unfortunately, it goes beyond that. Your patient may sue you if they even believe that they were harmed in some way, or think that something untoward happened while you were providing care. Here are the top 10 reasons for getting sued and my thoughts on each (in no particular order). 

#1. “What we have here is a failure to communicate”

Your interpersonal skills are at least as important as your clinical skills! You may be a clinical prodigy, but if you are an asshole at the bedside, your patients will never appreciate your skills. You must be able to listen and empathize with your patient. Sit down, look at them eye to eye. Listen attentively. Don’t appear to be in a rush to get out of the room. You’d be surprised at how much more valuable information you will get and the relationship you create.

#2. “Work not documented is work not done”

This is my quote and it’s one of my favorites. Accurate, complete, timely, and legible documentation is a must! The legibility problem is fading with the widespread use of electronic health records (EHR, although this is creating new problems). Documentation, or lack thereof, will not get you sued. However, if you are involved in a suit or claim and your care is scrutinized, poor or missing documentation will make it impossible to plausibly contend that you did what you say you did. 

It’s critical that you document every encounter thoroughly enough to be able to reconstruct what you were thinking and what you did. And providing a date and time is absolutely critical. This is especially important when the EHR timestamps everything you enter. Frequently, you will be documenting something somewhat after the fact. Always make sure that it’s not too far after the fact. Document as promptly as you can, and include the time that you were actually providing the service. 

And never go back and try to “correct” your documentation, especially if the chart is being requested for inclusion in a suit or claim. If you believe there is an error, create an addendum and explain why the correction is necessary. If a suit or claim has been started, do not touch or open the chart without advice from your legal counsel.

Tune in for Part 2 in my next post!

Do Trauma Surgeons Really Get Sued More Often? Part Two

There has always been a perception that trauma patients sue more often than other patients, and that trauma surgeons get sued more often than surgeons who do not provide trauma care. In several surveys polling surgical residents, this perceived malpractice risk is an impediment to considering a trauma practice. It is also frequently cited as a reason why established general surgeons do not want to engage in trauma care.

It is difficult to objectively study this area. Data sources are few and far between, and it is often difficult to get denominator information to determine the true incidence of lawsuits against trauma surgeons.

The University of Texas at San Antonio performed a nice study looking at their experience over a 12 year period. They compared the number of malpractice actions brought by patients who were undergoing an elective general surgical procedure, patients who underwent urgent or emergent general surgical procedures, and those who were classified as trauma patients.

They found that there were only 21 lawsuits served over the 12 year period, during which over 62,000 operations were performed. Seven were dismissed, 3 were granted summary judgments in favor of the physicians, and one went to trial and was decided in favor of the surgeon. Only half (10) were decided in favor of the patient. All were settled, with a total of $4.7 million in payouts. Legal defense costs were $1.3 million.

The ratios of lawsuits to operations performed were 3.0/100,000 for elective, 2.3/100,000 for urgent/emergent, and 3.1/100,000 for trauma. Given the total number of trauma patients evaluated, the ratio was 0.34 lawsuits per 100,000 trauma patients per year.

The bottom line: Health care is a complicated process, and there are bound to be a few adverse outcomes. The majority of these occur due to reasons that we do not yet fully understand. Lawsuits are rare, and as long as the physicians adhere to the standard of care, they frequently prevail. The idea that trauma surgeons get sued more frequently or more successfully than our non-trauma surgical colleagues is a fallacy that needs to finally be laid to rest.

Related post: Do trauma surgeons really get sued more often? Part one

Reference: Stewart et al. Trauma Surgery Malpractice Risk: Perception vs Reality. Annals of Surgery 241(6):969, 2005.

Do Trauma Surgeons Really Get Sued More Often? Part One

The graph above shows the incidence of lawsuits for a variety of medical specialties. General surgeons are in the middle of the pack. Although all trauma surgeons are general surgeons, not all general surgeons are trauma surgeons. This means that it is possible that the true lawsuit risk of this small minority of general surgeons is masked. 

Tomorrow I will look more specifically at the malpractice risk of trauma surgeons alone. 

Related post: Do trauma surgeons really get sued more often? Part two.

Reference: Medical Board of California Annual Report, 2008-2009.